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Joint Bone Spine. 2016 May;83(3):314-7. doi: 10.1016/j.jbspin.2015.07.011. Epub 2015 Dec 18.

Risk of cutaneous adverse events with febuxostat treatment in patients with skin reaction to allopurinol. A retrospective, hospital-based study of 101 patients with consecutive allopurinol and febuxostat treatment.

Author information

1
Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France. Electronic address: thomas.bardin@lrb.aphp.fr.
2
Rheumatology department, University of Rennes 1, hôpital Sud, CHU de Rennes, Rennes, France.
3
Rheumatology department, University Hospital of Lille, and University of Lille 2, 59000 Lille, France.
4
Rheumatology department, Viggo Petersen center, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, 75205 Paris, France; Inserm, UMR 1132, 75010 Paris, France.
5
Université Paris-Est Créteil, 94000 Créteil, France.
6
Orgamétrie biostatistiques, 59512 Roubaix, France.

Abstract

OBJECTIVE:

To investigate the cutaneous tolerance of febuxostat in gouty patients with skin intolerance to allopurinol.

METHODS:

We identified all gouty patients who had sequentially received allopurinol and febuxostat in the rheumatology departments of 4 university hospitals in France and collected data from hospital files using a predefined protocol. Patients who had not visited the prescribing physician during at least 2 months after febuxostat prescription were excluded. The odds ratio (OR) for skin reaction to febuxostat in patients with a cutaneous reaction to allopurinol versus no reaction was calculated. For estimating the 95% confidence interval (95% CI), we used the usual Wald method and a bootstrap method.

RESULTS:

In total, 113 gouty patients had sequentially received allopurinol and febuxostat; 12 did not visit the prescribing physician after febuxostat prescription and were excluded. Among 101 patients (86 males, mean age 61±13.9 years), 2/22 (9.1%) with a history of cutaneous reactions to allopurinol showed skin reactions to febuxostat. Two of 79 patients (2.5%) without a skin reaction to allopurinol showed skin intolerance to febuxostat. The ORs were not statistically significant with the usual Wald method (3.85 [95% CI 0.51-29.04]) or bootstrap method (3.86 [95% CI 0.80-18.74]).

CONCLUSION:

The risk of skin reaction with febuxostat seems moderately increased in patients with a history of cutaneous adverse events with allopurinol. This moderate increase does not support the cross-reactivity of the two drugs.

KEYWORDS:

Allopurinol; Cross-reactivity; Febuxostat; Gout; Severe cutaneous adverse reaction (SCAR); Skin reaction

PMID:
26709250
DOI:
10.1016/j.jbspin.2015.07.011
[Indexed for MEDLINE]

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